‘Closing the gap’, a new report from The Health Foundation, The King’s Fund and Nuffield Trust sets out key areas for action on the health and care workforce, saying “Urgent action is now required to avoid a vicious cycle of growing shortages and declining quality.”
Its recommended actions will require investment of an extra £900 million per year by 2023/24 into the budget of Health Education England.
The report has a particular focus on nursing and general practice, where it acknowledges the problems are particularly severe: on current trends, in 10 years’ time the NHS will have a shortfall of 108,000 full-time equivalent nurses. However, it also stresses the need to make the NHS a better place to work and build a career for all staff.
‘Closing the gap’ wants to see an explicit statement of the universal ‘offer’ to NHS setting out what staff can expect in terms of pay and opportunity, ongoing professional development, work-life balance, proper appraisal, legal rights and fair treatment for all.
Staff retention should be addressed through meaningful action on equality and inclusion, pay and rewards which need to continue to rise in real terms beyond the current Agenda for Change pay deal and more flexibility in the pension scheme which is often cited as a barrier to staff retention, particularly for more experienced staff.
An acceleration of investment in staff to develop new skills to meet changing patient needs and technological advances is essential as current progress is too slow. The report believes a fourfold increase in the current workforce development budget is required to accelerate change and support people.
Compassionate and inclusive leadership will be necessary to successfully implement many of the report’s recommendations, as will a sensible approach to training and funding. On workforce planning in the future, the report states: “The workforce has not been a policy priority: responsibility for it is fragmented nationally and locally, the information the NHS needs to understand and plan its workforce remains poor, and the NHS has not invested in the leadership capability and skills needed to manage the workforce effectively. The government cannot continue to view education and training as an overhead cost to be minimised. The forthcoming NHS Workforce Implementation Plan needs to address not just specific policy areas but also the roles, responsibilities, skills and capabilities needed across the system for more effective workforce planning. But above all, it is a plan that needs to be properly funded.”
Responding to the report, Sara Gorton, UNISON Head of Health, says: “Unless real efforts are made to attract new recruits and stop experienced health workers from leaving, today’s staffing gap problems will still be felt across the entire NHS for years to come.
“Pay and better training are key. Last year’s three-year deal has started to make a real difference but the investment behind it cannot be a one-off. Future governments will need to keep NHS wages competitive and be prepared to put in the necessary resources.
“Attracting graduates into the NHS is important but so is the stream of potential talent that can be trained into higher-skilled jobs via apprenticeships.
“Staff in lower paid jobs know the environments they work in and as apprentices, they can move into nursing and other professional roles to ease local staffing pressures. But the model needs central funding and a relaxation of the rigid levy rules to make it work for staff and patients.”
Sara is also Chair of the NHS Trade Unions and she outlines what the trade unions want to see the Workforce Implementation Plan concentrate on:
* Improved support for apprenticeships across the system to establish this as a reliable route into healthcare occupations - this must include financial support for backfill and flexibility around unspent levy
* Continued investment in pay - recent staff survey results showing a marked improvement in staff satisfaction in pay will be squandered if the Agenda for Change deal was a one-off; staff need confidence that their wages will keep pace with costs
* Better and more structured support for staff to develop their careers within the health and care sector, including restoration of continuing professional development budgets
* A ‘flexibility pledge’ that takes a cultural rather than transactional role to management and agreement of non-standard working patterns.
* Reducing harm to staff through a system-wide approach to prevention of violence.
Meanwhile, in an interview with HSJ [paywalled], Julian Hartley, Senior Responsible Officer for the awaited Workforce Implementation Plan and Chief Executive of Leeds Teaching Hospitals NHS Trust has confirmed that workforce investment will need to take account of the spending review, which is due later this year (autumn).
Click here to download the full report.
